Cambodia Helps Find Gene Marker for Drug-Resistant Malaria

A team of researchers from six universities and institutes in New York, Paris and Cambodia say they have found a genetic marker for a drug-resistant strain of the deadliest form of malaria, a discovery they hope will help health workers staunch its spread.

About two years ago, researchers identified markers for malaria strains resistant to the artemisinin in Artemisinin-based Combination Therapies (ACTs), the front-line drugs used in the fighting against the deadly mosquito-borne parasite.

But as the name implies, ACTs combine artemisinin with a variety of partner drugs to which malaria is also developing resistance, in what the authors of the new study described as an “alarming situation.”

“The spread of these multi-drug resistant strains to other regions would be a public health catastrophe with disastrous consequences,” they said in a statement released on Friday.

Researchers at the Pasteur Institutes in Cambodia and Paris, along with help from colleagues at Columbia University in New York, say they have found a marker for one of those partner drugs—piperaquine. Their findings were published in The Lancet Infectious Disease journal last week.

The marker is a tell-tale sign in the parasite’s genetic code that quickly lets health workers know it’s resistant to piperaquine, sparing them the need to wait and see how patients are responding—or not responding—to the drug.

The sooner medical professionals know the locations where drug-resistant malaria is emerging, the sooner they can formulate plans to replace piperaquine with another partner drug that still works.

“This finding should pave the way for rapid monitoring strategies that enable public health policy makers to recommend effective antimalarial treatments adapted to the epidemiological situation,” the researchers said.

Resistance to piperaquine has already taken a hold in western Cambodia, where the government began replacing it with ACTs using mefloquine earlier this year.

Hul Rekol, who heads the government’s National Malaria Center, said piperaquine was still going strong in the eastern provinces, but believed the new marker would be of little value in Cambodia because resistance to the drug was already well mapped out across the country.

“I don’t think it is too useful for Cambodia because we already know where they [resistant areas] are,” he said.

But the point of the marker is not only to confirm where resistance has taken hold, but where it is just emerging.

The health community’s greatest fear is that resistance to artemisinin and its partner drugs will spread to Africa, where malaria claims the great majority of its victims.

Earlier this year, the Pasteur Institute in Cambodia joined a global study that helped confirm that artemisinin-resistant malaria had not yet reached Africa.

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